tag:theconversation.com,2011:/au/topics/tanf-35724/articlesTANF – The Conversation2018-12-05T11:41:14Ztag:theconversation.com,2011:article/1077622018-12-05T11:41:14Z2018-12-05T11:41:14ZMedicaid work requirements: Where do they stand after the blue wave?<figure><img src="https://images.theconversation.com/files/248191/original/file-20181130-194925-klh28.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Laura Kelly, governor-elect of Kansas, was part of the blue wave in November. Kelly, shown here in October, opposes Medicaid work requirements. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Election-2018-Kansas-Governor/41792ac188b248268427536a6a36260d/1/0">AP Photo/John Hanna</a></span></figcaption></figure><p>The <a href="https://theconversation.com/the-votes-have-been-counted-the-results-are-mostly-in-whats-next-for-health-care-106574">2018 midterm elections</a> have dealt a significant setback to President Trump’s agenda in the <a href="https://read.dukeupress.edu/jhppl/article-abstract/43/2/271/133583">legislative arena</a>. </p>
<p>However, there are still many ways for the Trump administration to keep swinging away at the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1541-0072.2012.00446.x">Affordable Care Act</a>. One particularly effective unilateral instrument is the <a href="https://www.cambridge.org/core/journals/american-political-science-review/article/influence-and-the-administrative-process-lobbying-the-us-presidents-office-of-management-and-budget/638F34BC73235AB4833C852B24C431AF">regulatory process</a> – that is, the <a href="https://academic.oup.com/jpart/article-abstract/28/4/475/5056341">implementation of statutory law by executive agencies</a>.</p>
<p>This may prove particularly consequential for <a href="https://read.dukeupress.edu/jhppl/article-abstract/40/2/281/13726">Medicaid</a>, the health coverage program for those with low incomes or disabilities. One particular area of attention for scholars like me is <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">so-called community engagement or work requirements for Medicaid beneficiaries</a>. These mandates generally require beneficiaries to conduct work-related activities or lose coverage. </p>
<p>While still in litigation, the Trump administration has indicated its <a href="https://www.fiercehealthcare.com/payer/hhs-alex-azar-medicaid-work-requirements-hipaa-heritage-foundation">strong commitment to moving forward with these efforts</a>. </p>
<p>Helping individuals leave poverty is a worthwhile cause. As someone who studies health policy, I am concerned, based on research that others and I have conducted, that the focus of the Trump administration is misplaced. Indeed, their actions <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">run counter to a broad scholarly consensus</a> which universally emphasizes the benefits of health coverage. Most critically, they may disproportionately affect populations with vulnerabilities.</p>
<h2>Work for coverage: What the evidence from welfare reform tells us</h2>
<p>Work requirements have been implemented in a variety of public assistance programs outside of Medicaid. They have been featured most prominently in the <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">Temporary Assistance for Needy Families program</a>, or what Americans generally refer to as “welfare.” </p>
<p>When President Clinton and a Republican Congress <a href="https://www.theatlantic.com/business/archive/2016/04/the-end-of-welfare-as-we-know-it/476322/">“ended welfare as we know it”</a> in 1996, they imposed strict work requirements and time limits for beneficiaries. The resulting changes can only be described as transformational. Importantly, they include a <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">dramatic decline in the nation’s welfare case load</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/248192/original/file-20181130-194938-1mjspcu.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many people on Medicaid work, and many of those who do not wish they could find a job.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/construction-worker-285300212?src=L4ApcCx22gSFt9k1fBS-Eg-1-14">Zoran Orcik/Shutterstock.com</a></span>
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</figure>
<p>Proponents of work requirements have <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">hailed these developments</a> as vindication of the policy. More deliberate assessments, however, have raised questions about this interpretation. </p>
<p>For one, there is strong evidence that a significant reduction in caseload was a result of the <a href="https://www.hsdl.org/?view&amp;did=751040">strong economy in the late 1990s</a>. The reduction also coincided with the <a href="https://www.urban.org/sites/default/files/publication/61306/310282-How-Are-Families-That-Left-Welfare-Doing-.PDF">expansion of the Earned Income Tax Credit</a>, which made work more profitable for low-income earners. Additionally, a major portion of the reduction of the welfare load has been the <a href="https://www.brookings.edu/research/from-welfare-to-work-what-the-evidence-shows/">result of eligible individuals merely being diverted from the program</a>. </p>
<p>When it comes to the experience of people who benefit from Medicaid, more causes for concern emerge. Indeed, <a href="https://www.macpac.gov/wp-content/uploads/2017/10/Work-as-a-Condition-of-Medicaid-Eligibility-Key-Take-Aways-from-TANF.pdf">most employment and income gains have proven ephemeral</a>. </p>
<p>Individuals who were subject to work requirements generally <a href="https://www.brookings.edu/research/from-welfare-to-work-what-the-evidence-shows/">found only entry-level, low-paying jobs</a> without <a href="https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows">benefits</a>. </p>
<p>Moreover, employment is <a href="https://www.brookings.edu/research/from-welfare-to-work-what-the-evidence-shows/">often impermanent and therefore highly unstable</a>. </p>
<p>Critically, beneficiaries have also <a href="https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows">failed to transition into better-paying jobs over time</a>. As a result, they continue to <a href="https://www.urban.org/sites/default/files/publication/61306/310282-How-Are-Families-That-Left-Welfare-Doing-.PDF">struggle with housing and food security</a>. </p>
<p>Studies have found <a href="https://www.brookings.edu/research/from-welfare-to-work-what-the-evidence-shows/">no hard evidence for sustained reductions in poverty</a>.</p>
<p>And certain populations faced particularly negative impacts. These include those with significant employment barriers such as <a href="https://www.brookings.edu/research/from-welfare-to-work-what-the-evidence-shows/">chronic health conditions, low job skills, and low education status</a>. </p>
<p><a href="https://www.urban.org/sites/default/files/publication/95566/work-requirements-in-social-safety-net-programs.pdf">Minorities</a> appear to also be disproportionately affected. The same holds for those <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollees-and-work-requirements-lessons-from-the-tanf-experience/">suffering from addiction or domestic violence</a>. </p>
<p>Perhaps of greatest concern is evidence that for a significant portion of those beneficiaries forced off public assistance the result has been <a href="https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows">a slide into deep and persistent poverty</a>.</p>
<h2>Work requirements and the Trump administration</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=401&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/248193/original/file-20181130-194935-m1me3d.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=504&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pres. Trump speaking at a rally in Wilkes-Barre, Pennsylvania, Aug. 2, 2018.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wilkesbarre-pa-august-2-2018-president-1148319818?src=bIJn1M8li9AMc_Cs5-tArQ-1-8">Evan El-Amin/Shutterstock.com</a></span>
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<p>Since taking office, the Trump administration has sought to aggressively introduce work requirements into the <a href="https://read.dukeupress.edu/jhppl/article-abstract/40/2/281/13726">Medicaid program</a>. It has argued that doing so would <a href="https://thehill.com/policy/healthcare/408724-trump-administration-defends-medicaid-work-requirements-after-coverage">“put beneficiaries in control with the right incentives to live healthier, independent lives.” </a></p>
<p>It has done so using so-called <a href="https://www.kff.org/medicaid/issue-brief/section-1115-medicaid-demonstration-waivers-the-current-landscape-of-approved-and-pending-waivers/">1115 demonstration waivers</a>. These waivers allow states to make temporary changes to their Medicaid programs that omit certain <a href="https://www.cambridge.org/core/journals/journal-of-policy-history/article/inching-toward-universal-coverage-statefederal-healthcare-programs-in-historical-perspective/E94A03DD1F60F9DCBE3DDE9728DA3224">statutory requirements</a>. </p>
<p>These waivers have been traditionally used by both parties to expand, not reduce, coverage.</p>
<p>As a result, the Center for Medicare and Medicaid Services has received more than a dozen waiver requests seeking to implement work requirements from states like <a href="https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/">Kentucky, Arkansas and Michigan</a>. Proposals <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">differ significantly</a> between states in terms of such characteristics as work effort required, what activities count toward compliance and exemptions.</p>
<p>Yet due to <a href="https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/">legal issues</a>, the only program currently operational is in <a href="https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/">Arkansas</a>.</p>
<p>The <a href="https://www.apnews.com/d9d0613c59a2481a953074177c33170f">experience in Arkansas</a> appears emblematic for many efforts to impose work requirements. In particular, it illustrates what appears to be a deliberate attempt to reduce enrollment, rather than to help people leave poverty. </p>
<p>Work requirements, as implemented in Arkansas, are particularly concerning because they impose several significant burdens. One of these that has raised particular concern is <a href="https://www.healthaffairs.org/do/10.1377/hblog20180904.979085/full/">the requirement that Medicaid recipients report compliance of their work requirements solely to an online portal</a>. No provisions are made for beneficiaries to report in person, on paper or via phone. This is in a state that ranks at the <a href="https://www.citylab.com/equity/2018/08/arkansas-medicaid-work-requirements-online-reporting/567589/">bottom nationwide</a> when it comes to internet access. </p>
<p>Moreover, the portal is offline for a significant number of hours each day. There have also been no efforts to support beneficiaries’ work efforts such as job training, child care assistance or transportation allowances. </p>
<p>And indeed, early experiences confirm many of the fears of advocates and scholars alike, as <a href="https://www.healthaffairs.org/do/10.1377/hblog20180904.979085/full/">thousands of Arkansans have already lost coverage</a>. </p>
<p>Many of those losing coverage may have lost coverage not because of failure to work but instead <a href="https://www.healthaffairs.org/do/10.1377/hblog20180904.979085/full/">because they were unable to report their work efforts</a>.</p>
<h2>Supporting work instead of taking away health coverage</h2>
<p>Proponents of work requirements argue that <a href="https://www.wsj.com/articles/are-medicaid-work-requirements-a-good-idea-1529892000">requiring people to work will make them healthier and more economically secure</a>. Accompanying this argument is the assertion that many beneficiaries are willfully choosing not to work. Thus, beneficiaries have to be pushed into the workforce by a paternalistic government.</p>
<p>However, this line of argument runs counter to the <a href="https://publichealth.gwu.edu/sites/default/files/downloads/HPM/Kentucky%20Medicaid%20Proposed%20Amici%20Curiae%20Brief.pdf">expert consensus</a> that has emerged. Indeed, most scholars emphasizes the strong, positive effects that sustained health coverage has in supporting the work efforts of people who receive benefits. Taking away medical coverage runs contrary to the goal of alleviating poverty and transitioning Medicaid beneficiaries into stable work environments. </p>
<p>Blaming <a href="https://www.prb.org/majority-of-people-covered-by-medicaid-and-similar-programs/">Medicaid beneficiaries</a>, most of whom are indeed working, taking care of family members or disabled, for not working misses many of the subtleties of the underlying problems. Many beneficiaries face personal and systemic barriers such as lack of education, transportation or economic opportunity. <a href="https://www.dropbox.com/s/7ogsghmra0tdjbz/Haeder%20WV%20Medicaid%20Work%20Requirements%20Public.pdf?dl=1">Many are unable</a> to find long-term, stable jobs with health benefits despite their best efforts.</p>
<p>Yet, the effects of work requirements go well beyond the population targeted by them. Perhaps most concerning, work requirements may cause significant harm to populations with vulnerabilities such as minorities, the disabled and the chronically ill. Confusion, lack of information and the stresses of living in poverty may prove overwhelming. The results may be disenrollment. This holds even for <a href="https://wvpolicy.org/wp-content/uploads/2018/11/WV-Medicaid-Work-Requirements-Report.pdf">those who are technically exempted from work requirements</a>.</p>
<p>Unfortunately, this may not be a glitch but may point to the true underlying rationale. That is, the true goal for many supporters of work requirements may be the disenrollment of large numbers of beneficiaries, reductions in government expenditures and ultimately a disengagement from the social safety net. </p>
<p>Despite these concerns, one should not ignore the valid concerns of many working low- and middle-income Americans who are working and struggling. </p>
<p>I believe what the U.S. truly needs are policies that provide equitable opportunities for all Americans. A particular focus should be on offering access to affordable health care and education, and <a href="https://wvpolicy.org/wp-content/uploads/2018/11/WV-Medicaid-Work-Requirements-Report.pdf">policies that encourage, support and reward work</a>. Proven policy solutions to do this include expanding the Earned Income Tax Credit and providing access to affordable health care and educational opportunities. </p>
<p>Scholars play an important role in this process by informing policy choices with empirical evidence. We are also tasked to stand up and point out when our work is misrepresented in the political process. Finally, we have to be particularly mindful of those with vulnerabilities.</p><img src="https://counter.theconversation.com/content/107762/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon is a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation to equip teams of researchers and community partners in applying research to solve real community problems.</span></em></p>Republicans have sought to limit Medicaid, and a key component of those efforts is requiring that those who receive Medicaid benefits work. But many already do, and others can't, a scholar explains.Simon F. Haeder, Assistant Professor of Political Science, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890482017-12-13T11:22:37Z2017-12-13T11:22:37Z3 myths about the poor that Republicans are using to support slashing US safety net<figure><img src="https://images.theconversation.com/files/198817/original/file-20171212-9451-1baw0sz.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Sen. Chuck Grassley recently seemed to suggest some poor people spend all their money on &quot;booze or women or movies.&quot;</span> <span class="attribution"><span class="source">AP Photo/Charlie Neibergall</span></span></figcaption></figure><p>Republicans continue to use long-debunked myths about the poor as they defend <a href="https://www.forbes.com/sites/johntharvey/2017/12/02/economists-say-the-trump-tax-plan-will-have-disastrous-consequences/#207ea56c4209">lower taxes for the rich</a> and <a href="http://thehill.com/homenews/house/363642-ryan-pledges-entitlement-reform-in-2018">deep cuts to the social safety net</a> to pay for them. In so doing, they are essentially <a href="https://www.washingtonpost.com/blogs/plum-line/wp/2017/12/04/two-ugly-quotes-from-republicans-reveal-the-truth-about-their-tax-plan/?utm_term=.07ba3f41345c">expressing scorn</a> for working class and low-income Americans. </p>
<p>Sen. Chuck Grassley, for example, recently <a href="https://www.washingtonpost.com/news/morning-mix/wp/2017/12/04/grassley-explains-why-people-dont-invest-booze-or-women-or-movies/">justified</a> reducing the number of wealthy families exposed to the estate tax as a way to recognize “the people that are investing, as opposed to those that are just spending every darn penny they have, whether it’s on booze or women or movies.”</p>
<p>Similarly, Sen. Orrin Hatch <a href="http://www.politifact.com/truth-o-meter/article/2017/dec/05/context-orrin-hatchs-comments-about-chip-people-wh/">raised concerns</a> about funding certain entitlement programs. “I have a rough time wanting to spend billions and billions and trillions of dollars to help people who won’t help themselves, won’t lift a finger and expect the federal government to do everything,” he said.</p>
<p>These statements, the likes of which I expect we’ll all hear more of in coming months, reinforce three harmful narratives about low-income Americans: People who receive benefits don’t work, they don’t deserve help and the money spent on the social safety net is a waste of money. </p>
<p>Based on my <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2423540">research</a> and 20 years of experience as a clinical law professor representing low-income clients, I know that these statements are false and only serve to reinforce misconceptions about working class and poor Americans.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=404&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=404&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=404&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=507&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=507&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/198811/original/file-20171212-9451-1gx6e1w.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=507&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Food participants get an average of $125 a month, hardly enough to feed a family without earning money as well.</span>
<span class="attribution"><span class="source">AP Photo/Robert F. Bukaty</span></span>
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</figure>
<h2>Most welfare recipients are makers not takers</h2>
<p>The first myth, that people who receive public benefits are “takers” rather than “makers,” is flatly untrue for the vast majority of working-age recipients.</p>
<p>Consider Supplemental Nutrition Assistance Program benefits, formerly known as food stamps, which currently serve about <a href="http://www.newsweek.com/people-food-stamps-snap-decline-participation-640500">42 million Americans</a>. At least one adult in more than half of SNAP-recipient households <a href="https://www.cbpp.org/research/policy-basics-introduction-to-the-supplemental-nutrition-assistance-program-snap">are working</a>. And the average SNAP subsidy is $125 per month, or $1.40 per meal – hardly enough to justify quitting a job.</p>
<p>As for Medicaid, nearly <a href="https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/">80 percent of adults</a> receiving Medicaid live in families where someone works, and more than half are working themselves.</p>
<p>In early December, House Speaker <a href="http://edition.cnn.com/2017/12/06/politics/paul-ryan-entitlement-reform/index.html">Paul Ryan said</a>, “We have a welfare system that’s trapping people in poverty and effectively paying people not to work.” </p>
<p>Not true. Welfare – officially called Temporary Assistance to Needy Families – has <a href="http://www.aphsa.org/content/dam/NASTA/PDF/CRS-RPT_R44751_2017-02-01.pdf">required work</a> as a condition of eligibility since then-President Bill Clinton signed welfare reform into law in 1996. And the <a href="https://www.irs.gov/credits-deductions/individuals/earned-income-tax-credit/do-i-qualify-for-earned-income-tax-credit-eitc">earned income tax credit</a>, a tax credit for low- and moderate-income workers, by definition, supports only people who work.</p>
<p>Workers apply for public benefits because they need assistance to make ends meet. American workers are among <a href="http://time.com/4621185/worker-productivity-countries/">the most productive in the world</a>, but over the last 40 years the bottom half of income earners have seen <a href="http://equitablegrowth.org/research-analysis/republican-tax-plan-slams-workers-and-job-creators-in-favor-of-the-rich-and-inherited-wealth/">no income growth</a>. As a result, since 1973, worker productivity has <a href="http://www.epi.org/productivity-pay-gap/">grown almost six times</a> faster than wages. </p>
<p>In addition to wage stagnation, most Americans are spending more than <a href="https://www.bls.gov/news.release/cesan.nr0.htm">one-third of their income</a> on housing, which is increasingly unaffordable. There are 11 million renter households paying more than <a href="http://www.jchs.harvard.edu/sites/jchs.harvard.edu/files/harvard_jchs_state_of_the_nations_housing_2017_chap1.pdf.">half their income</a> on housing. And there is <a href="http://nlihc.org/oor">no county</a> in America where a minimum wage worker can afford a two-bedroom home. Still, only <a href="http://nlihc.org/sites/default/files/oor/OOR_2017.pdf">1 in 4</a> eligible households receive any form of government housing assistance.</p>
<p>To be sure, there are recipients of public benefits who do not work. They are primarily children, the disabled and the elderly – in other words, <a href="https://www.thoughtco.com/who-really-receives-welfare-4126592">people who cannot or should not work.</a> These groups constitute the majority of public benefits recipients.</p>
<p>Society should support these people out of basic decency, but there are self-interested reasons as well. To begin with, all working adults have been children, will someday be old and, at any time, might face calamities that take them out of the workforce. The safety net exists to rescue people during these vulnerable periods. Indeed, most people who receive public benefits leave the programs within <a href="https://www.census.gov/newsroom/press-releases/2015/cb15-97.html">three years</a>.</p>
<p>Moreover, many public benefits pay for themselves over time, as healthier and financially secure people are more productive and contribute to the overall economy. For example, <a href="https://www.cbpp.org/research/policy-basics-introduction-to-the-supplemental-nutrition-assistance-program-snap">every dollar in SNAP spending</a> is estimated to generate more than $1.70 in economic activity. </p>
<p>Similarly, Medicaid benefits are associated with enhancing <a href="https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/">work</a> opportunities. The <a href="https://www.cbpp.org/research/federal-tax/eitc-and-child-tax-credit-promote-work-reduce-poverty-and-support-childrens">earned income tax credit</a> contributes to work rates, improves the health of recipient families and has long-term educational and earnings benefits for children. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=412&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=412&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=412&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=517&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=517&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/199016/original/file-20171213-27588-15tfh1m.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=517&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The current federal minimum wage is hardly enough to feed a family.</span>
<span class="attribution"><span class="source">AP Photo/Kiichiro Sato</span></span>
</figcaption>
</figure>
<h2>What the needy deserve</h2>
<p>The second myth is that low-income Americans do not deserve a helping hand. </p>
<p>This idea derives from our belief that the U.S. is a meritocracy where the most deserving rise to the top. Yet where a person ends up on the income ladder is tied to where they started out. </p>
<p>Indeed, America is not nearly as socially mobile as we like to think. Forty percent of Americans born into the bottom-income quintile – the poorest 20 percent – will stay there. And the same “<a href="https://www.washingtonpost.com/news/wonk/wp/2016/10/06/striking-new-research-on-inequality-whatever-you-thought-its-worse/?utm_term=.074d818b5336">stickiness</a>” exists in the top quintile. </p>
<p>As for people born into the middle class, only 20 percent will ascend to the top <a href="https://www.newyorker.com/magazine/2014/03/03/the-mobility-myth">quintile</a> in their lifetimes.</p>
<p>The third myth is that government assistance is a waste of money and doesn’t accomplish its goals. </p>
<p>In fact, poverty rates would <a href="https://www.cbpp.org/blog/safety-net-cut-poverty-nearly-in-half-last-year;">double</a> without the safety net, to say nothing of human suffering. Last year, the safety net lifted <a href="https://www.cbpp.org/research/poverty-and-inequality/chart-book-accomplishments-of-the-safety-net">38 million</a> people, including 8 million children, out of poverty.</p>
<h2>The facts of welfare</h2>
<p>In trotting out these myths, Republican lawmakers are also tapping into long-standing <a href="https://www.washingtonpost.com/news/posteverything/wp/2017/12/08/republicans-are-bringing-welfare-queen-politics-to-the-tax-cut-fight/?utm_term=.8d360a5ce417">racist stereotypes</a> about who receives support. For instance, the “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2423540">welfare queen</a>” – a code word for an African-American woman with too many children who refuses to work – is a fiction.</p>
<p>The facts of welfare are that most recipients are white, families that receive aid are smaller on average than other families and the program requires recipients to work and is tiny in relation to the overall federal budget – <a href="http://econofact.org/welfare-and-the-federal-budget">about half a percent</a>. Yet, the welfare queen is an archetype invoked to generate public antagonism against the safety net. Expect her to make frequent appearances in the months to come.</p>
<p>Americans should demand fact-based justifications for tax and entitlement reforms. It is time to retire the welfare queen and related tropes that paint needy Americans as undeserving.</p><img src="https://counter.theconversation.com/content/89048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michele Gilman is affiliated with the American Civil Liberties Union of Maryland and the Women&#39;s Law Center of Maryland.
</span></em></p>As the GOP prepares to slash spending to pay for tax cuts, lawmakers have been bringing up claims about the poor that don't stand up to scrutiny.Michele Gilman, Venable Professor of Law, University of BaltimoreLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/813642017-08-03T01:04:39Z2017-08-03T01:04:39ZHow welfare's work requirements can deepen and prolong poverty: Rose's story<figure><img src="https://images.theconversation.com/files/180601/original/file-20170801-9618-1yjlnb6.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Losing welfare benefits when they&#39;re between jobs can plunge nursing home aides into extreme economic hardship.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rehab-elderly-people-536383975?irgwc=1&amp;utm_medium=Affiliate&amp;utm_campaign=Hans%20Braxmeier%20und%20Simon%20Steinberger%20GbR&amp;utm_source=44814&amp;utm_term=">GagliardiImages/Shutterstock.com</a></span></figcaption></figure><p>After “Rose” lost her low-wage job in a southeast Michigan nursing home, the single mother of four sought Temporary Assistance to Needy Families (TANF) benefits. </p>
<p>People who are eligible for this federal, time-limited welfare program for very low-income families must be <a href="https://www.theatlantic.com/politics/archive/2017/03/why-work-requirements-in-medicaid-wont-work/520593/">working or looking for work</a>, a feature the Trump administration and other politicians want to spread to Medicaid and other similar programs that support low-income Americans. Rose obtained the benefits but lost them after finding that the program was doing little to help her get a job and interfering with her parenting. </p>
<p>This fairly common experience suggests that these restrictions can prolong and worsen spells of poverty. Like many experts on American poverty relief, I don’t see why that punitive strategy makes sense. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/180604/original/file-20170801-15290-xxprax.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wisconsin Gov. Scott Walker wants to reduce food stamp benefits for families with children whose parents who do not work at least 80 hours a month or meet related requirements.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Wisconsin-Welfare-Reforms/66d979d426fb469aa85aa0650569c344/1/0">AP Photo/Scott Bauer</a></span>
</figcaption>
</figure>
<h2>Work requirements</h2>
<p>When Rose told me her story while I was researching what happens to women like her, she started by saying, “I’m ashamed.” But it sounded like she wasn’t to blame. She was embarrassed about how she had lost her job, but her explanation showed just how tough a spot she had been in.</p>
<p>After working double shifts for a week straight and completing her duties on a Friday night at about 2:30 a.m., “I dozed off. Me and a coworker,” she said. “It’s documented that it wasn’t even 20 minutes that we had dozed off, and a supervisor walked in. We were suspended at that time.” She got fired shortly thereafter.</p>
<p>Rose enrolled in a local job search program. Some of these programs sent participants on job interviews, but Rose, like many of the 22 women I interviewed, said few got hired. The program wanted her to return to the training site after interviews at the end of the day. </p>
<p>“By that time, the kids are getting out of school. You’ve got to get back home, or you’ve got to go pick the kids up from daycare, and I thought that was pointless to do that,” Rose recounted. “If you didn’t come back, you were considered noncompliant, so you’d be cut off just like that.”</p>
<p>After months without securing a job and struggling to pick her children up from school on time, Rose opted for the “noncompliant” label. This meant losing US$440 a month in TANF payments, her only source of cash income until, six months later and through her own efforts, she found another low-paying job in a different nursing home. During those six months, Rose sometimes couldn’t afford diapers, which meant her youngest child sometimes went without them. When she ran out of food a couple of times, she would send her children to relatives to eat while she went hungry.</p>
<p>Rose’s experience illustrates the downsides of inflexible work requirements. Instead of getting help finding a new job during those six months, she joined the <a href="http://www.urban.org/sites/default/files/publication/27521/412393-Dynamics-of-Being-Disconnected-from-Work-and-TANF.PDF">swelling ranks</a> of families with no cash from welfare or jobs, some of whom wind up scraping by on incomes of <a href="http://www.twodollarsaday.com/">$2 a day or less</a> – a common metric for poverty in developing countries. Typically headed by single mothers, these families are cut off from or otherwise unable to access welfare while also having no earnings. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=441&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=441&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=441&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=554&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=554&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/180607/original/file-20170801-14630-16cum4k.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=554&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">House Democratic Leader Nancy Pelosi has urged President Donald Trump not to slash funding that helps families with children that are experiencing poverty.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pelosi-Poverty-Rally/dd2185cfb7504b029536372846547623/4/0">AP Photo/Reed Saxon</a></span>
</figcaption>
</figure>
<h2>Harsh labor market</h2>
<p>Working on a team with researchers from the Urban Institute, an independent think tank, I found that almost two-thirds of the mothers we interviewed were able to rely upon partners or family members for help. Yet this can <a href="http://www.rsfjournal.org/doi/full/10.7758/RSF.2015.1.1.08">strain the resources</a> of people who are not much better off than them. Some may <a href="https://www.acf.hhs.gov/sites/default/files/opre/dynamicsofdisconnection_finalreport.pdf">lose housing</a>, which leads them to double up with friends, send children to live with relatives or stay in shelters. </p>
<p>Although more research is needed before we know whether lacking access to welfare makes poor families prone to homelessness, families living in extreme poverty are nearly twice as likely to report <a href="http://www.rsfjournal.org/doi/full/10.7758/RSF.2015.1.1.07">housing instability</a> as other low-income families.</p>
<p>You could say that Rose was reaping the consequences of bad choices because she broke a rule. But as I argue in “<a href="https://www.russellsage.org/publications/abandoned-families">Abandoned Families</a>,” my book about the economic and political changes that have thwarted opportunities for upward mobility, the low-wage labor market is harsh. </p>
<p>National data on workplace conditions are scarce, but studies of <a href="http://mysouthsidestand.com/more-news/workers-stories/">cities</a> and certain <a href="http://ssa.uchicago.edu/what-are-hours">occupations</a> have found that unsafe workplace conditions, irregular and unpredictable scheduling, and <a href="https://www.labor.ucla.edu/wage-theft/">wage theft</a> are common. For example, more than 30 percent of low-wage workers in <a href="http://mysouthsidestand.com/more-news/workers-stories/">Syracuse</a> told researchers that their jobs caused a health problem. Many of the women I profiled in “Abandoned Families” told me they worked for employers who violated their rights, and mistakes were greeted with threats of or actual termination. </p>
<p>Should Rose have made arrangements for afterschool care for her children? Perhaps, but it’s not fair to presume that this was a viable option for her. The demand for <a href="http://www.afterschoolalliance.org/Essentials_and_Polling_2013_032713.pdf">care after classes end for the day</a> far outstrips its availability: An estimated 18.5 million more children would be in such programs were they available in their community. Yet <a href="http://www.clasp.org/resources-and-publications/publication-1/CCDBG-Participation-2015.pdf">funding to help low-income parents pay</a> for it is declining. The federal government spent $11.3 billion on child care in 2014, down from $12.9 billion in 2011.</p>
<h2>A poor model</h2>
<p>The frustrating experiences of women like Rose should make policymakers pause before considering <a href="https://www.cbpp.org/research/food-assistance/snap-helps-millions-of-low-wage-workers">extending work requirements</a> to other programs serving low-income families.</p>
<p>Consider the situation with SNAP, the Supplemental Nutrition Assistance Program more widely known by its pre-2008 name, food stamps. More than 60 percent of the households getting SNAP benefits that <a href="https://www.cbpp.org/research/food-assistance/snap-helps-millions-of-low-wage-workers">have children</a> and what budget director Mick Mulvaney likes to call “<a href="https://www.theatlantic.com/politics/archive/2017/05/the-trump-budget-is-the-mulvaney-budget/527700/">able-bodied</a>” adults have at least one employed member. Others are led by working-class people who are hunting for a new job. About one-third of all households with SNAP nutritional benefits earn at least some money from work, according to the <a href="https://www.cbpp.org/research/food-assistance/snap-helps-millions-of-low-wage-workers">Center for Budget and Policy Priorities</a>, a think tank.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img alt="" src="https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=594&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=594&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=594&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=747&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=747&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/180212/original/file-20170728-18243-1kqbzvh.png?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=747&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In most households getting SNAP benefits that include at least one nonelderly and nondisabled adult, one or more members were earning money in 2015, even without a work requirement.</span>
<span class="attribution"><a class="source" href="https://www.cbpp.org/research/food-assistance/snap-helps-millions-of-low-wage-workers">Center for Budget and Policy Priorities</a></span>
</figcaption>
</figure>
<p>My study showed that work requirements don’t always help people find jobs. Ultimately, the penalties imposed for failure to meet these rules can wind up punishing low-income kids and prolonging hard times.</p><img src="https://counter.theconversation.com/content/81364/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Funding for the research that is cited in the article was provided by the U.S. Department of Health and Human Services - Office of the Assistant Secretary for Planning and Evaluation; the U.S. Department of Health and Human Services - Administration for Children and Families; the Economic Research Service of the U.S. Department of Agriculture; the Annie E. Casey Foundation; and the Center for Local, State, and Urban Policy - University of Michigan.</span></em></p>Only very low-income Americans who are working or looking for work are eligible for federal, time-limited welfare dollars. This restriction doesn't always help them get back on their feet.Kristin Seefeldt, Assistant Professor of Social Work, School of Social Work, Assistant Professor of Public Policy, Gerald R Ford School of Public Policy, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/813672017-08-01T00:17:35Z2017-08-01T00:17:35ZWelfare as we know it now: 6 questions answered<figure><img src="https://images.theconversation.com/files/179898/original/file-20170726-28585-6xhxyw.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">When President Bill Cllinton officially ended welfare as we knew it, he was flanked by women who had received Aid to Families with Dependent Children.</span> <span class="attribution"><a class="source" href="http://pictures.reuters.com/C.aspx?VP3=SearchResult&amp;VBID=2C0BXZNAYW76Z&amp;SMLS=1&amp;RW=1195&amp;RH=684&amp;POPUPPN=36&amp;POPUPIID=2C0408YJW9N">Reuters/Stephen Jaffee</a></span></figcaption></figure><p><em>President Donald Trump’s proposed budget would slice <a href="https://www.washingtonpost.com/graphics/politics/trump-budget-benefits-cuts/?utm_term=.6fe8a036bc8a">US$21.7 billion over a decade, or 13.1 percent</a>, from Temporary Assistance for Needy Families (TANF) – what’s left of basic welfare for families facing economic hardship. To justify this cut and an across-the-board reduction in <a href="https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/budget.pdf">antipoverty spending</a>, he argued, “We must reform our welfare system so that it does not discourage able-bodied adults from working, which takes away scarce resources from those in real need.”</em> </p>
<p><em>But, as political scientist Laura Hussey explains, that’s already the case. Today’s welfare system is short-term and reserved mainly for children.</em></p>
<h2>What is TANF?</h2>
<p>TANF provides cash assistance and other services to children and their parents or guardians who can work and are extremely poor. States, sometimes through local governments, administer the program and help fund it.</p>
<p>It replaced the welfare program known first as Aid to Dependent Children and later renamed Aid to Families with Dependent Children. In 1996, President Bill Clinton and the Republican-led Congress <a href="https://www.congress.gov/bill/104th-congress/house-bill/3734/text">overhauled the welfare system</a>, creating TANF. This modern welfare system’s main goals boil down to:</p>
<ol>
<li><p>Help families in need care for their own children.</p></li>
<li><p>Get families off welfare quickly, especially through paid work.</p></li>
<li><p>Encourage marriage and two-parent families while discouraging unmarried and teen pregnancy.</p></li>
</ol>
<p>Fulfilling Clinton’s campaign promise to “<a href="https://www.brookings.edu/book/ending-welfare-as-we-know-it/">end welfare as we know it</a>,” the law tied time limits and other, sometimes intrusive, mandates to cash grants. Among other changes, it converted the federal program into a block grant model, letting states use these dollars how they wanted. It converted this antipoverty program into aid contingent on efforts to <a href="http://onlinelibrary.wiley.com/doi/10.1002/pam.21880/full">enter or reenter the workforce</a> through new job requirements. In 2012, the most recent year for which comprehensive data are available, more than 42 percent of TANF families included <a href="https://aspe.hhs.gov/system/files/pdf/116161/FINAL%20Fourteenth%20Report%20-%20FINAL%209%2022%2015.pdf">an employed household member</a>.</p>
<h2>How many Americans get TANF benefits?</h2>
<p>The <a href="https://www.cbpp.org/research/family-income-support/tanf-reaching-few-poor-families">1.5 million American families</a> who obtained TANF benefits in a typical month in 2015 represent roughly 23 percent of those experiencing poverty. In contrast, AFDC, the precursor program, supported 4.7 million families in 1995 – 76 percent of the nation’s poor families. </p>
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<h2>Who gets TANF benefits?</h2>
<p>More than three out of four of the people who get these benefits are children. For a <a href="http://digitalcommons.ilr.cornell.edu/key_workplace/1504/">growing share</a> of TANF “families” – nearly half in 2015 – <a href="https://www.acf.hhs.gov/ofa/resource/characteristics-and-financial-circumstances-of-tanf-recipients-fiscal-year-2015">the only beneficiaries are minors</a>. </p>
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<p>Most of these children who are the only people in a household getting benefits either reside with guardians or have parents who are aren’t eligible themselves. Ineligible parents who live in poverty might be immigrants, people who receive disability-related assistance or adults who would qualify if they hadn’t broken TANF rules, such as failing to fully comply with a work requirement or submit required paperwork.</p>
<p>In those cases, families keep receiving the children’s part of the grant. This reflects a reluctance by policymakers to punish kids for their parents’ status or behavior.</p>
<h2>How long do people get these benefits?</h2>
<p>Most TANF recipients get benefits for short periods of time. From 2008 to 2011, as the Great Recession ended, most of them were out of the program within four months or less. The vast majority of Americans who got TANF benefits from 1999 to 2008 received it for no more than <a href="https://aspe.hhs.gov/system/files/pdf/116161/FINAL%20Fourteenth%20Report%20-%20FINAL%209%2022%2015.pdf">two of those years</a>, according to the Department of Health and Human Services. </p>
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<p>The federal government cuts off TANF benefits for families with an adult recipient after a total of 60 months. States may set their own ceiling below five years if they want or make an exception to this lifetime limit for up to 20 percent of their TANF cases, based on exceptional hardship. They can also use their own money to continue cash benefits for families that hit that five-year quota, which applies to adults but not children.</p>
<h2>How does the program vary across the country?</h2>
<p>TANF cash grants averaged $442 per family <a href="https://www.acf.hhs.gov/sites/default/files/opre/2015_welfare_rules_databook_final_09_26_16_b508.pdf">as of July 2015</a>. The maximum monthly grant available to households with one adult and two children ranged from a low of $170 in Mississippi to a maximum of $923 in Alaska.</p>
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<h2>What does TANF fund?</h2>
<p>After two decades under the block grant model that gives states discretion over how to spend TANF dollars, cash grants typically consume only a <a href="https://www.acf.hhs.gov/ofa/resource/tanf-financial-data-fy-2015">small share of this money</a>.</p>
<p>States may spend federal TANF funds on other activities serving its official purposes, as well as such things as foster care, juvenile justice and what the government calls “emergency assistance” – goods or services that help meet children’s basic needs amid short-term hardships. </p>
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<p>States spent on average about a quarter of federal TANF funds on “basic assistance” – mostly as cash grants – in 2015 and 16 percent on child care. Another 10 percent funded “work, education and training activities,” including subsidies to employers that hire people enrolled in the program and services designed to help them get jobs. “Work supports,” benefits that cover expenses such as transportation to job interviews, uniforms and occupational licensing, averaged 2.5 percent of TANF funds. </p>
<p>The remaining fifth of federal TANF dollars funded an array of efforts to promote two-parent families, reduce domestic violence and topple what the government says are “barriers” to work and self-sufficiency, like substance abuse counseling. Not all of this money helps the poor. Michigan spends some of its federal welfare dollars, for example, on college scholarships for <a href="https://www.marketplace.org/2016/06/09/wealth-poverty/how-welfare-money-funds-college-scholarships">high-income families</a>.</p>
<p>Despite not covering most U.S. families living in poverty, the states ended the year with $1.4 billion in committed but unspent federal TANF funds, plus $2.3 billion more that they are saving for future years.</p><img src="https://counter.theconversation.com/content/81367/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Hussey does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Trump's rationale for cutting the Temporary Assistance to Needy Families program rests on a myth at odds with contemporary data.Laura Hussey, Associate Professor, Department of Political Science, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/812412017-07-26T01:53:16Z2017-07-26T01:53:16ZThe bigotry baked into welfare cuts<figure><img src="https://images.theconversation.com/files/179523/original/file-20170724-6656-pvglfu.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Relatively few low-income Americans are getting welfare payments these days.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bad-financial-situation-crisisspending-money-high-594201662">Christine Hoi/Shutterstock.com</a></span></figcaption></figure><p>The <a href="https://budget.house.gov/budgets/fy18/">budget blueprint</a> the House of Representatives recently unveiled isn’t a carbon copy of President Donald Trump’s proposal, dubbed “<a href="https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/budget.pdf">A New Foundation for American Greatness</a>.” But they would both make what’s left of the already tattered safety net for the poor a lot weaker.</p>
<p>As a scholar of American poverty and the policies meant to alleviate it, I find that one of the most troubling things about these cuts is the role of bigotry. Like other politicians before him, Trump uses “<a href="https://global.oup.com/academic/product/dog-whistle-politics-9780190229252?cc=us&amp;lang=en&amp;">dog whistles</a>” – coded racist messages – to demonize the poor, signal that they don’t deserve support and justify cutbacks. </p>
<p>Trump is perhaps more apt to disparage noncitizens than some of his predecessors and he tends to be more explicit when he <a href="http://billmoyers.com/story/dog-whistle-politics-racism/">smears nonwhites</a> while using terms like “<a href="https://www.theatlantic.com/business/archive/2016/10/trump-african-american-inner-city/503744/">inner cities</a>” as shorthand for African-Americans and “the illegals” to disparage Latinos. </p>
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<h2>Baffled experts</h2>
<p>Consider what <a href="http://www.foxnews.com/politics/2017/06/22/trump-in-iowa-president-calls-for-barring-immigrants-from-welfare-for-five-years.html">Trump told supporters</a> at an Iowa rally in June:</p>
<blockquote>
<p>“The time has come for new immigration rules that say … those seeking immigration into our country must be able to support themselves financially and should not use welfare for a period of at least five years.”</p>
</blockquote>
<p>This baffled experts since immigrants are already <a href="https://www.nilc.org/issues/economic-support/overview-immeligfedprograms/">barred from receiving welfare</a> in most cases. But Trump has also proposed preventing undocumented immigrants from getting <a href="http://www.washingtonexaminer.com/trump-calls-to-cut-off-tax-breaks-for-illegal-immigrants/article/2623845">earned income and child tax credits</a>, even if they have U.S.-born citizen children.</p>
<p>As scholars like <a href="https://www.law.berkeley.edu/our-faculty/faculty-profiles/ian-haney-lopez/">Ian Haney López</a> argue, Trump’s dog-whistling about newcomers casts them as nonwhites who pose a threat to white America.</p>
<h2>Cuts upon cuts</h2>
<p>This demonization has laid the groundwork for some of the harshest cuts Trump has proposed, which take aim at <a href="https://www.cbpp.org/research/policy-basics-an-introduction-to-tanf">Temporary Assistance for Needy Families</a> (TANF). The states administer this time-limited welfare program with strict work requirements, parceling out those funds as they see fit. Less than half of the money covers cash payments to the poor and child care programs. The rest funds job training and other priorities, such as <a href="https://www.cbpp.org/research/despite-inclusion-of-marriage-promotion-funding-budget-bill-would-penalize-states-that">encouraging marriage</a>.</p>
<p>Spending on TANF has already <a href="https://www.cbpp.org/blog/president-trumps-budget-cuts-tanf-despite-stated-goal-to-reduce-poverty-boost-work">fallen by a third</a> in inflation-adjusted dollars since the federal government “reformed” the welfare system in 1996. Aid to Families with Dependent Children (AFDC), the program that morphed into TANF, supported 4.7 million families in 1995 – 76 percent of the nation’s poor families. By 2015, the number of poor families getting TANF benefits had fallen to 1.5 million, representing roughly 23 percent of that population.</p>
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<p>Yet, Trump’s budget calls for <a href="https://www.cbpp.org/blog/president-trumps-budget-cuts-tanf-despite-stated-goal-to-reduce-poverty-boost-work">cutting TANF by another 13 percent</a>, a US$2.2 billion reduction in the 2018 fiscal year. Trump’s proposed cuts are not limited to TANF and <a href="http://www.nbcnews.com/politics/white-house/trump-budget-would-cut-safety-net-programs-boost-defense-spending-n763236">span the entire safety net</a>, including large cuts for spending on food stamps – now called Supplemental Nutrition Assistance Program (SNAP), as well as Medicaid, the Earned Income Tax Credit, housing assistance and other programs. </p>
<p>If the cuts go through, they will hit millions of low-income families hard. As spending on assistance has declined over the past two decades, the number of American families living on as little <a href="http://www.twodollarsaday.com">$2 per person per day</a> has tripled, according to some estimates. The 1.5 million households in that demographic include about three million children.</p>
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<figcaption><span class="caption">Getting by on $2 a day requires selling plasma and resorting to other survival strategies, scholar Kathryn J. Edin explained in this PBS NewsHour interview.</span></figcaption>
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<h2>Dog whistles</h2>
<p>Since Trump campaigned as a different kind of Republican who would not cut basic social welfare programs, his proposed budget cuts violate some of his promises. </p>
<p>“The forgotten men and women of our country will be forgotten no longer,” Trump pledged in his <a href="https://www.usatoday.com/story/news/nation/2017/01/20/his-own-words-president-trumps-inaugural-address/96836330/">inauguration speech</a>. </p>
<p>Here’s one explanation that I think explains this duplicity: He really only meant whites. Using bigotry to demonize immigrants, the poor and others helps solidify support among his base by playing on <a href="http://www.people-press.org/2017/04/17/1-views-of-trump/">their prejudices</a>. </p>
<p>When tea party Republicans started getting elected in 2010, they reignited a politics of bigotry to resist Barack Obama, the first U.S. nonwhite president. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1540-5907.2011.00577.x/abstract">Michael Tesler</a>, a University of California, Riverside professor, calls this the “Obama effect.” Trump’s candidacy and presidency have built on that <a href="http://www.politifact.com/truth-o-meter/article/2017/jun/27/trump-says-time-has-come-immigration-law-barring-i/">resurgent prejudice</a>. </p>
<p>Trump’s dog-whistling got louder when he took it upon himself to become a leader of the so-called “birther” movement to spread unfounded suspicions that Obama was a <a href="http://www.cnn.com/2016/09/09/politics/donald-trump-birther/index.html">Kenyan-born Muslim</a>, with comments like this one from 2011.</p>
<blockquote>
<p>“Obama "doesn’t have a birth certificate, or if he does, there’s something on that certificate that is very bad for him. Now, somebody told me – and I have no idea if this is bad for him or not, but perhaps it would be – that where it says ‘religion,’ it might have ‘Muslim.’ And if you’re a Muslim, you don’t change your religion, by the way.”</p>
</blockquote>
<p>Whereas Republican presidential nominee John McCain was quick to <a href="http://time.com/4866404/john-mccain-barack-obama-arab-cancer/">refute</a> such lies when he ran against Obama in 2008, <a href="https://www.facebook.com/attn/videos/926428204059306/">Trump indulged these smears </a>. As he leveraged this racial resentment, he acquired support among a white nationalist base that <a href="https://www.usnews.com/opinion/articles/2016-08-19/why-donald-trumps-kkk-and-white-supremacist-supporters-matter">endorsed his presidency</a>.</p>
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<h2>Us versus them</h2>
<p>Trump’s repeated smears about Obama’s nationality and religion were more than an attempt to discredit his predecessor. They not only conveyed a coded message that Obama wasn’t qualified to lead our country but by extension a sense that communities of color were undeserving. </p>
<p>Trump’s rhetoric amplifies an “<a href="http://nymag.com/daily/intelligencer/2017/05/the-trump-budget-is-based-on-discredited-delusions.html">us versus them</a>” perspective that suggests his <a href="https://www.theatlantic.com/politics/archive/2017/05/white-working-class-trump-cultural-anxiety/525771/">white supporters</a> are the real victims. He signals that he will stand up for them and against supposed interlopers threatening their well-being and safety.</p>
<p>Racism has always hampered American poverty alleviation, but starting in the 1960s, <a href="http://press.uchicago.edu/ucp/books/book/chicago/W/bo3633527.html">consistently misleading media coverage</a> and cynical politicians led the American public to mistakenly consider welfare a “black program” that mostly serves undeserving non-whites, as political scientist Martin Gilens has documented.</p>
<p>That is far from the case today. Only 30 percent of the families getting TANF benefits were black <a href="https://www.acf.hhs.gov/ofa/resource/characteristics-and-financial-circumstances-of-tanf-recipients-fiscal-year-2015">in 2015</a>, while 28 percent were non-Hispanic white and 37 percent Latino. The remaining 6 percent were either Asian-American or the government put them into different ethnic categories. Combined, the number of non-Hispanic whites and Hispanic whites together total <a href="https://www.census.gov/prod/2011pubs/p70-127.pdf">just over half</a> the welfare population. </p>
<h2>Welfare discrimination at the state level</h2>
<p>In my research, I have found that bigotry colors how <a href="https://www.cbpp.org/research/family-income-support/state-fact-sheets-how-states-have-spent-funds-under-the-tanf-block">states administer welfare</a>. </p>
<p>A 2001 study I co-authored showed that the generosity of a state’s welfare program tends to be correlated with the share of its beneficiaries who are white. States where <a href="http://www.jstor.org/stable/2669347?origin=JSTOR-pdf">people of color</a> represent a majority on the welfare rolls generally make their benefits more meager and impose tough eligibility requirements. The handful of states like Oregon – where two-thirds of TANF <a href="https://www.theatlantic.com/business/archive/2016/05/welfare-utopia/484607/">recipients are white</a> – usually run the most <a href="http://www.urban.org/research/publication/why-does-cash-welfare-depend-where-you-live/view/full_report">generous welfare programs</a>.</p>
<p><a href="https://thinkprogress.org/mississippi-reject-welfare-applicants-57701ca3fb13">Mississippi</a>, for example, pays at most $170 a month to families of three that somehow get approved and enrolled. Only 1.42 percent of the state’s 11,000 TANF applicants last year managed to clear that hurdle, according to state data obtained by ThinkProgress. More than four out of five of Mississippi’s 14,061 TANF beneficiaries were black in 2015 and only eight out of every 100 poor families in Mississippi got these benefits. In comparison, 43 out of every 100 poor families <a href="https://www.cbpp.org/sites/default/files/atoms/files/tanf_spending_or.pdf">in Oregon</a> were TANF beneficiaries, according to the Center for Budget and Policy Priorities, a think tank.</p>
<p>Trump is only the latest politician to deploy dog whistles to leverage bigotry. Like the many other politicians who did this long before he joined in, he is using coded disparagement to justify slashing aid to people facing extreme economic hardship.</p><img src="https://counter.theconversation.com/content/81241/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sanford Schram is Professor of Political Science, Hunter College and the Graduate Center, CUNY. </span></em></p>Misleading stereotypes help explain why the share of families living in poverty who benefit from a core assistance program has plummeted -- and why Trump wants new cuts.Sanford Schram, Professor of Political Science, Hunter College, CUNY Graduate CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/713032017-02-13T01:51:27Z2017-02-13T01:51:27ZTrump wants to change Medicaid funding; could his ideas work?<p>Medicaid, which has provided safety net health care for millions of Americans with low incomes <a href="https://www.cms.gov/About-CMS/Agency-Information/History/index.html">since 1965</a>, pays for medical care for about <a href="http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/">75 million people in the U.S.</a>, including almost two-thirds of those in nursing homes. </p>
<p>You likely know someone who benefits from Medicaid. It could be someone whose nursing home care is paid by Medicaid, even if that person at one time had retirement savings, a home and a good income. The costs of long-term care are such that, if a person was not poor when he or she became disabled or old, there’s a good chance that he or she will soon become poor. Medicaid pays for about <a href="http://kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/">six million people</a> in nursing homes. </p>
<p>Medicaid also pays for medical care for about <a href="http://kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/">10 million children and adults</a>. You might know a young adult who is covered by Medicaid and who grew up with a diagnosis like cystic fibrosis or kidney disease that made it impossible to work as an adult. </p>
<p>Medicaid accounts for <a href="http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/">about 17 percent of the nation’s health care expenditures in 2015</a>. In 2015, the government spent about <a href="http://kff.org/medicaid/state-indicator/total-medicaid-spending/?currentTimeframe=0">US$532 billion</a> on the program. </p>
<p>President Trump and other GOP leaders not only want to repeal the ACA but also to change Medicaid’s funding mechanism to something called block grants. Trump believes the change will save the federal government billions of dollars, and that could be true. </p>
<p>A study presented Feb. 6 to Congress by Avalere Health, a D.C.-based health care consulting firm, forecast savings of <a href="http://thehill.com/policy/healthcare/318164-study-block-granting-medicaid-would-save-federal-government-150-billion">$150 billion by 2022.</a>
But a switch to block grants could also leave millions of poor people without insurance, or it could lead to cutbacks in services they receive.</p>
<p>As a social worker and instructor who has worked with and taught about Medicaid and other health policy systems including block grants over the past 25 years, I can say that going to block grants for Medicaid will represent a disruptive change. Looking at how block grants have affected a long-standing poverty alleviation program shows that there is some risk involved. </p>
<h2>Block grants 101</h2>
<p>Block granting is a structure of federal funding in which a set sum of money is allocated to states within a period of time, for use in the way the states see fit to meet a specified need.</p>
<p>Block grant funding for Medicaid would differ significantly from how Medicaid is funded now. For the most part, Medicaid now operates as either a negotiated fee-for-service system or a monthly rate per Medicaid enrollee. The federal government pays a portion of the expenses, and <a href="https://www.medicaid.gov/medicaid/financing-and-reimbursement/index.html">state government pays the other portion</a>.</p>
<p>Many in the GOP support the block grant plan, citing block grant funding that has been used for <a href="http://apps.washingtonpost.com/g/page/politics/read-the-house-gops-poverty-report/850/">Temporary Assistance to Needy Families</a> (TANF). In the TANF program, states are allocated an established amount of funding to “to help needy families <a href="https://www.acf.hhs.gov/ofa/programs/tanf/about">achieve self-sufficiency</a>.” States design and implement programs, with minimal federal guidelines, to achieve their TANF goals. </p>
<p>Some states spend more funding on basic assistance and work supports, while other states spend more funding on child care and tax credits for <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">working families with low incomes</a>. </p>
<p>Some see the variation in the use of funds as a strength while others see it as ineffective. The 2014 <a href="http://apps.washingtonpost.com/g/page/politics/read-the-house-gops-poverty-report/850/">GOP House report</a> indicated TANF “is widely seen as the most successful reform of a welfare program.”</p>
<p>Depending on how you view the numbers, that could be true.</p>
<p>Caseload <a href="http://apps.washingtonpost.com/g/page/politics/read-the-house-gops-poverty-report/850/">levels for cash assistance fell</a> from 5.1 million households in the 1980s to 1.9 million households in 2010. Some point to those numbers as evidence of fewer families living in poverty. </p>
<h2>Block grants 102</h2>
<p>There’s more to that story, however. Others see TANF as a failure, and they cite the structure of TANF as a <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">block grant as the cause</a>.</p>
<p>Viewing the <a href="http://www.cbpp.org/research/tanf-weakening-as-a-safety-net-for-poor-families">lower TANF caseloads as evidence of less need or poverty</a> may not be accurate, because TANF caseloads continued to decline even in times of recession when poverty levels increased.</p>
<p>Thus, lower TANF caseloads may not actually be tied to less need but instead to families being unable to receive benefits due to changes in TANF structure. </p>
<p>It’s hard to know for certain whether the switch to block grants is responsible, but the rate of potentially eligible TANF recipients receiving TANF assistance has fallen from <a href="https://www.acf.hhs.gov/sites/default/files/opre/change_time_1.pdf">86 percent in 1992 to 36 percent in 2007</a>. Meanwhile, the <a href="http://nlihc.org/article/welfare-reform-increased-deep-poverty-among-children">number of children living in deep poverty</a> (income less than 50 percent of the federal poverty level) in the U.S. has risen from 1.5 to 2.2 million between 1995 and 2005. </p>
<p>Those families living in deep poverty <a href="http://www.cbpp.org/research/family-income-support/chart-book-tanf-at-20">are now less able to count on TANF </a>for assistance like they did in 1995. Then, 61 percent of children living in poverty would have been in deep poverty without TANF assistance. More recently, only 24 percent of children living in poverty would be in deep poverty without TANF assistance, making it appear that TANF is no longer serving the families with the most need.</p>
<h2>When budget shortfalls occur, block grant money looks tasty</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=237&amp;fit=clip" srcset="https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=494&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=494&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=494&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=620&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=620&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/156092/original/image-20170208-17345-1l1x11i.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=620&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Preschoolers painting.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/572584078?size=huge_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>And, many who view TANF as a failure blame the block grant system, precisely because states have leeway to use TANF funding according to what they deem most appropriate. States have <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">shifted away</a> from spending the majority of their allocated funding on the core functions of TANF, including basic assistance, child care and work-related supports. </p>
<p>Instead, they spend money in areas such as child welfare/protective services and and pre-K programs, which are normally funded by states. In essence, the states use their federal dollars for budget shortfalls in other areas.</p>
<p>These services, while important, are not included in the core functions of the TANF program. States are spending about half of TANF funds <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">outside the core function areas </a>.</p>
<p>For example, <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">Texas spent 38 percent of TANF funds</a> on Pre-k and Early Headstart in 2015. <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">Half of TANF funds in Georgia were spent </a>on child welfare/protective services in the same year. </p>
<p>In addition to the issues with usage of federal dollars, the federal TANF block grant funding <a href="http://www.cbpp.org/research/family-income-support/how-states-use-funds-under-the-tanf-block-grant">does not include an adjustment for inflation</a>, so it has lost one-third of its value since 1997. States are now being asked to provide TANF services with less funding. </p>
<h2>Applying lessons learned to Medicaid</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" srcset="https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/156090/original/image-20170208-17337-1or7sem.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Trump moved swiftly to try to repeal Obamacare, signing an executive order his first day in office.</span>
<span class="attribution"><span class="source">Evan Vucci/AP.</span></span>
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<p>Medicaid is a much larger program than TANF, and the effects could be much larger. About <a href="http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid">$476 billion was spent</a> on Medicaid services in 2014, meaning the financial risks are much higher depending on how states manage their block grant funds. </p>
<p>With the emphasis on more flexibility and less federal government oversight, the federal government could <a href="http://www.ncd.gov/publications/2013/05222013/">move away</a> from federal regulations for Medicaid and allow states to have the maximum control over service provision systems.</p>
<p>While this could lead to innovation, it could also put some vulnerable citizens at risk. The needs of the most vulnerable in health care coverage systems, the chronically ill, the disabled, the elderly, are <a href="http://www.cbpp.org/blog/why-rhode-islands-no-model-for-a-medicaid-block-grant">often the most expensive to meet</a>. States with the lowest budgets for health care to combine with federal block grant funding might experience <a href="http://www.cbpp.org/sites/default/files/atoms/files/5-3-11health.pdf">deep cuts in Medicaid services</a>, affecting the health of many.</p>
<h2>The poor could be very, very vulnerable</h2>
<p>There are few who question that the move to Medicaid block grants would save the federal government money. The federal government will save the most money by the establishment of Medicaid block grants that don’t fluctuate in funding levels <a href="http://www.cbpp.org/sites/default/files/atoms/files/5-3-11health.pdf">due to the economic environment or with greater demand</a>, like in an epidemic.</p>
<p>States, though, will have to either budget to plan for those circumstances or cut services when the need gets too high. It’s this last point that could create a shift in the fundamental ideology behind Medicaid as an entitlement program, which guarantees certain benefits to particular groups of people. </p>
<p>The transition of Medicaid to a block grant system may give so much flexibility to states and create a funding system so undependable in times of crisis that Medicaid can no longer be considered a true entitlement or a safety net. As with the TANF program, it will be the vulnerable who stand to lose the most.</p>
<p><em>This article was updated on Feb. 14 to indicate the figure regarding government spending on Medicaid includes federal and state money.</em></p><img src="https://counter.theconversation.com/content/71303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cossy Hough does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Trump has proposed a major funding shift for Medicaid, the joint federal-state program that pays for health care for about 75 million poor people. Would the safety net fray if he did so?Cossy Hough, Clinical Assistant Professor School of Social Work, University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.